The world needs more health-care workers — millions more

The most impressive part of any hospital or health clinic are the caring, skilled employees who prevent and treat illness. But the workforce we have is not enough As I visit health programs in far off corners of the world and right here at home, the most impressive part of any hospital or clinic are the health workers themselves — the hands behind the health care that is provided to mothers and newborns, to children and the elderly, to teens and adults to prevent and treat illness. 

Health workers heal. It's as simple as that. And in this country, and around the world, there are not enough of them. Doctors are included in that shortage, but it doesn't stop there. Recent estimates suggest the world is short some 4 million to 5 million community health workers, midwives, pharmacists, lab technicians, nurses, and doctors. Fifty-seven countries have severe health workforce shortages — meaning there are less than 23 clinicians per 10,000 people.  

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And health workers, particularly in developing countries, are scarcest in the poorest communities and neighborhoods — both rural and urban — where poverty, poor sanitation and disease conspire to take the lives of children and adults from preventable killers like pneumonia, diarrhea, pregnancy complications, and TB. 

Fifty-seven countries have severe health workforce shortages.

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Later this week I am heading back to Haiti with the Clinton Bush Haiti Fund to review past investments in sustainable human health capital.  Haiti is in dire need of indigenous health workers who are from and remain committed to their local communities. Longterm health and economic results can only be achieved by partnering with Haitians to build health training and service programs that they own and that they populate. 

In targeted areas around the world, training armies of much-needed health workers has become a smart, key goal of U.S. foreign assistance. We are helping train new midwives, community health workers, lab technicians, and nurses through partnering programs supported by the U.S. Agency for International Development, the NIH, and the CDC. These new health workers are serving in communities hardest hit by infectious diseases and the complications from pregnancy and childbirth. 

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And it works! Countries that have made a concerted effort to increase the numbers and skills of their health workforce have shown tremendous progress: Malawi has trained more than 10,000 health surveillance assistants in the past 20 years and in the same period, child mortality dropped almost 60 percent. In India, turning normal community members into lay health workers to support healthier newborn care practices reduced newborn deaths by over 50 percent.

Training community-level health workers does not have to be expensive — people who can provide the most basic levels of treatment for sick children and promote healthy practices can be trained for as little as $300. More skilled community health workers and midwives cost roughly 10 times that amount to train.  These workers provide the life-saving interventions needed to address most of the leading causes of death of newborns and children — all with no need for huge medical school bills. It's basic health care, but it is life saving.

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Highlighting the humble service of health workers around the world is the subject of a campaign launched by Save the Children, with whom I have traveled to countries like Bangladesh and Mozambique to witness these health workers going about their daily tasks. The care is effective and affordable. In fact, I think we in the U.S. have a lot to learn from these community health workers delivering local care. Take a look at some of the powerful stories at www.goodgoes.org, where you glimpse the simple and affordable care provided by people who go the extra mile on behalf of others. 

No matter what diseases and conditions are threatening, and what new technologies for treatment might come along, we can say for sure that progress will depend on an expanded army of health workers, properly trained and placed, with the right skills and supplies, intent on delivering the best quality health care possible.

As we look at America's international assistance around the world, surely one of the best examples of success can be seen in the faces of these committed community servants.

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Obama's health-care law is hurting insurance agents and millions of consumers

The national health-care reform law‘s unintended consequences have been well catalogued. This month marks a year since President Obama’s Affordable Care Act, sometimes called Obamacare, put into play one of its lesser known, but most damaging provisions.

If you’ve never heard of the law’s medical loss ratio (MLR) provision, you’re certainly not alone. This simple calculation has had the effect of radically reducing what health insurance agents earn. That, in turn as greatly restricted their ability to help million of Americans navigate the maze of approvals needed for medical procedures and processing claims. It has also had a devastating effect on these agents’ businesses and is disrupting the insurance market.

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At the end of last year, state insurance commissioners took a big step to undo some of the damage done by the Patient Protection and Affordable Care Act. The National Association of Insurance Commissioners approved a resolution urging Congress to remove health insurance agents’ compensation from the law’s medical loss ratio provision. In the meantime, the association wants the Obama administration to what it can to mitigate the negative impact of the provision.

So what does that mean? 

The MLR provision states that insurers must dedicate at least 80 percent of individual and small group premiums they receive to medical- or quality-improvement expenses. The figure goes up to 85 percent for large group policies. Because agents’ compensation counts against the MLR (along with such items as marketing expenses and corporate profits), many insurance companies immediately slashed commissions when the provision went into effect last January.

Insurers having to put such a high portion of the premiums collected toward these expenses meant that agents – on the frontlines of helping customers – made less and had to cut services to compensate.

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A November survey by the National Association of Insurance and Financial Advisors found that 80 percent of health insurance agents saw their commissions decrease, including 52 percent whose companies cut commissions by 25 percent or more, since the health-care law went into effect last January. A report by the Government Accountability Office confirmed this, stating that “almost all of the insurers said they had decreased or planned to decrease commissions to brokers in an effort to increase their MLRs.”

If it sounds like it’s a tough time to be an insurance agent, it is. Their median annual income was less than $50,000 before the law went into effect. Many are small business owners who can no longer afford to pay their employees.

But the problem is much more serious than that. It’s getting tougher to be a consumer in the market for health insurance, too. Unlike agent compensation, premiums have not gone down. And while removing compensation from the MLR would not cause premiums to increase, there have been a slew of unintended consequences from leaving it in.

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Agents do much more than sell insurance. They serve their clients, not the insurance companies, helping people when they have trouble getting surgical procedures and tests approved or claims processed. They provide corporate clients with individual enrollment assistance for their employees. They create and administer company wellness programs and often serve as the extended human resources departments for small business clients.

As agents deal with the consequences of the MLR, many are finding that the cost of servicing clients now exceeds their income. They are cutting back on services to customers and laying off support staff. Some are leaving the health insurance business altogether, effectively reducing the competition that the health-care law was supposed to foster. All of this is disrupting the marketplace.

That’s why I applaud the efforts of the National Association of Insurance Commissioners. The commissioners are well respected and have a long history of protecting consumers and ensuring the stability of the insurance market. Their opinion rightfully carries weight among decisionmakers in Washington.

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Congress and the president certainly never intended for the law to limit consumers’ health-care choices or reduce the quality of their coverage. As President Obama has acknowledged, “Anything can be improved.” Treating agents’ compensation as a pass-through item and thereby removing it from the MLR equation would be a huge improvement and a first step toward ensuring that Americans continue to have access to the essential support and customer service that professionally trained and licensed agents provide. 

Robert Miller is president of the National Association of Insurance and Financial Advisors, based in Falls Church, Va. NAIFA comprises more than 600 state and local associations representing the interests of 200,000 members and their associates nationwide.

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